What do mobile health and underserved populations have to offer each other?

By Jonah Comstock
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JONAH_COMSTOCK_HEADSHOTBack in August, I wrote about how the rich and famous were adopting health wearables. But what about the other end of the spectrum? Recent Pew data shows that lower income people are the most likely to have one or more chronic disease, but the least likely to use a health app. Developing mobile health technologies for low income and underserved populations doesn't just have the potential to help those populations -- it could also help the entrepreneurs that choose to take advantage of it.

StartUp Health seems to have reached the same conclusion: the incubator just received a $500,000 grant from the Robert Wood Johnson Foundation to launch a new program to help health entrepreneurs help underserved communities. Over two years, StartUp will help educate entrepreneurs on how to focus on markets that don't usually have early access to new healthcare technologies. They will create resources to teach startups to engage with underserved communities and also to give those communities an improved awareness of emerging technologies.

This topic is one that a number of academic researchers have looked into. Andrea Parker, a computer scientist at Northeastern University, is doing research on how mobile tools can support lower income populations, specifically working with low-income families in the Boston neighborhood of Roxbury. She told me earlier this fall that underserved communities are something of a blind spot for many health developers.

"I think the applications that are out there right now, and the health monitoring devices, there's a lot of great systems out there," she said. "I think probably they have the potential to help people of all socioeconomic, all cultural backgrounds. But it appears they have not been designed specifically with a lower income background involved. And in the research that's been done there hasn't been an explicit focus on what are the specific needs of these populations."

Dr. Ivor Braden Horn, a pediatrician at the Children's National Medical Center in Washington DC, said that minorities and low income people just aren't in the room when conversations about personal health device or health app development take place.

"The biggest challenge is when you're doing work, you work in the community where you are, and there are very few minorities there. So there are a lot of developers coming into the health space who don't have the exposure and don't have the experience, so they don't get that perspective," she said.

Parker and Horn both agreed that the difference between just trying to design for everyone and specifically considering underserved populations, is that oftentimes underserved populations face challenges that developers can simply fail to consider. For instance, apps that give suggestions on how to cook nutritious meals can have great health value -- but only if the users have a grocery store in their neighborhood that sells the necessary ingredients, the money to afford it, and the time to cook. Similarly, activity trackers and apps may have value in changing behavior around exercise, even for kids -- but only in areas where adults and children feel safe walking around.

And Horn says there's a benefit to developers who consider these groups, who have the potential to be great customers. By some accounts, they already are great customers for non-health apps and devices.

"African American consumers are projected to have a spending power of $1.1 trillion by 2013," she said in a talk earlier this year at the Healthcare Experience Design conference in Boston. "Hispanics are projected to have a spending power of $1.5 trillion. Not to mention that minority populations are early adopters, especially when it comes to mobile. They purchase apps and go online more than their majority counterparts."

Horn said that lower-income populations are more likely to be mobile-first users: Because they can't always afford broadband connections at home, they're more likely to go online exclusively via mobile. Horn also said that uninsured people are one of the largest groups looking online for health information.

"If you're uninsured, you use Dr. Google for different reasons," she said. "It's not Dr. Google because 'I'm curious', it's Dr. Google because 'If I don't have to go to the doctor, I don't want to go to the doctor'. It's Dr. Google because 'I can't afford [a doctor]'."

Parker also said that it's important to note that low-income communities don't only present disadvantages. Her research also shows advantages these communities have in being close-knit and often having strong community leaders, through which it's easier to scale effective programs.

"There are organizations that are trying to do something about the presence of disease in these neighborhoods," she said. "There are key leaders who want to make changes. Because there are people who recognize 'This is a problem in my community', there is this broader focus on 'How can I help my community improve this issue?' That presents an interesting opportunity."

Some of Parker's research is focused on finding ways to use apps focused on improving physical activity that are community- and family-based, not just individualized. One system she developed had parents and kids track activity during the week on mobile devices and then use that activity to unlock an exergame at a Saturday community meet-up.

"A lot of our participants talk about how physical activity was enjoyable for them, because it made them feel more connected with their child," she said. "Our goal is to be like, ok, if we can observe these different values and think about how design can leverage this activity, maybe this will be even more effective at encouraging activity."

Horn talked about the value of grassroots in low income communities and launching campaigns that make use of not only the virtual space, but also the real world. She said that Text4Baby working with media company FeelRich and R&B singer Tyrese Gibson last year, which culminated in a large outdoor community event, was a good example of this kind of outreach.

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